Hemispheric asymmetry of transcallosal inhibition in man

Lateralization of unimanual and bimanual motor imagery

Most studies of motor imagery have examined motor cortex function during imagery of dominant hand movement. The aim of this study was to examine the modulation of excitability in the dominant and non-dominant corticomotor pathways during kinesthetic motor imagery of unimanual and bimanual movement. Transcranial magnetic stimulation (TMS) was applied over the contralateral motor cortex (M1) to elicit motor-evoked potentials (MEPs) in the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles of each hand, in two separate sessions. Transcutaneous electrical stimuli were also delivered to the median nerve at each wrist, to elicit F-waves from APB. Fifteen right-handed volunteers imagined unimanual and bimanual phasic thumb movements, paced with a 1-Hz auditory metronome. Stimuli were delivered at rest, and either 50 ms before (ON phase), or 450 ms after (OFF phase), the metronome beeps. Significant MEP amplitude facilitation occurred only in right APB, during the ON phase of motor imagery of the right hand and both hands. Significant temporal modulation of right APB MEP amplitude was observed during motor imagery of right, left and bimanual performance. F-wave persistence and amplitude were unaffected by imagery. These results demonstrate that the motor imagery is lateralized to the left (dominant) hemisphere, which is engaged by imagery of each hand separately, and bimanual imagery. This finding has implications for the use of motor imagery in rehabilitation.

Hand Motor Recovery After Stroke: Tuning the Orchestra to Improve Hand Motor Function

The motor deficits after stroke are not only the manifestation of the injured brain region, but rather the expression of the ability of the rest of the brain to maintain function. After a lesion in the primary motor cortex, parallel motor circuits might be activated to generate some alternative input to the spinal motoneurons. These parallel circuits may originate from areas such as the contralateral, undamaged primary motor area, bilateral premotor areas, bilateral supplementary motor areas, bilateral somatosensory areas, cerebellum, and basal ganglia. Most importantly, the efferent, cortico-spinal output pathways must be preserved for a desired behavioral result. Most of the recovery of function after a stroke may represent actual relearning of the skills with the injured brain. The main neural mechanisms underlying this relearning process after stroke involve shifts of distributed contributions across a specific neural network (fundamentally the network engaged in skill learning in the healthy). If these notions are indeed correct, then neuromodulatory approaches, such as transcranial magnetic stimulation, targeting these parallel circuits might be useful to limit injury and promote recovery after a stroke. This paper reviews the stroke characteristics that can predict a good recovery and compensations across brain areas that can be implemented after a stroke to accelerate motor function recovery.

Spatiotemporal mapping of cortical activity accompanying voluntary movements using an event-related beamforming approach

We describe a novel spatial filtering approach to the localization of cortical activity accompanying voluntary movements. The synthetic aperture magnetometry (SAM) minimum-variance beamformer algorithm was used to compute spatial filters three-dimensionally over the entire brain from single trial neuromagnetic recordings of subjects performing self-paced index finger movements. Images of instantaneous source power ("event-related SAM") computed at selected latencies revealed activation of multiple cortical motor areas prior to and following left and right index finger movements in individual subjects, even in the presence of low-frequency noise (e.g., eye movements). A slow premovement motor field (MF) reaching maximal amplitude approximately 50 ms prior to movement onset was localized to the hand area of contralateral precentral gyrus, followed by activity in the contralateral postcentral gyrus at 40 ms, corresponding to the first movement-evoked field (MEFI). A novel finding was a second activation of the precentral gyrus at a latency of approximately 150 ms, corresponding to the second movement-evoked field (MEFII). Group averaging of spatially normalized images indicated additional premovement activity in the ipsilateral precentral gyrus and the left inferior parietal cortex for both left and right finger movements. Weaker activations were also observed in bilateral premotor areas and the supplementary motor area. These results show that event-related beamforming provides a robust method for studying complex patterns of time-locked cortical activity accompanying voluntary movements, and offers a new approach for the localization of multiple cortical sources derived from neuromagnetic recordings in single subject and group data.

A TMS study on non-consciously triggered response tendencies in the motor cortex

Non-consciously perceived arrow stimuli can speed up responses to similar stimuli that are shortly presented after a masked prime. Yet response facilitation may turn into a delay at particular intervals between masked primes and targets. In this case, the lateralized readiness potential, as a measure of the time course of differential activation between the primed and the unprimed motor cortices, consistently yielded two consecutive maxima of opposite polarity, at 250 and at 350 ms after prime onset. To further explore the mechanisms underlying inverse priming, we used single-pulse transcranial magnetic stimulation (TMS) of the left or right primary motor hand area (M1). Lateralized changes in corticomotor excitability induced by the masked prime were probed by assessing the effect of priming on the amplitude of the TMS-induced motor-evoked potentials (MEPs). In two experiments, MEPs increased and decreased, respectively, in the hand primed by the masked arrows when TMS was given at 250 and at 350 ms after prime onset, confirming the expectation that MEP changes may indicate the response tendencies induced by the masked primes. Both effects were more distinct with TMS of the left M1. However, there were also some differences between the patterns of results in the two experiments. We propose that the left M1 is activated for preparation of both right- and left-hand movements, and we relate the present results to current hypotheses about the nature of inverse priming.

Dynamics of hemispheric specialization and integration in the context of motor control

Behavioural and neurophysiological evidence convincingly establish that the left hemisphere is dominant for motor skills that are carried out with either hand or those that require bimanual coordination. As well as this prioritization, we argue that specialized functions of the right hemisphere are also indispensable for the realization of goal-directed behaviour. As such, lateralization of motor function is a dynamic and multifaceted process that emerges across different timescales and is contingent on task- and performer-related determinants.

Suppression of the non-dominant motor cortex during bimanual symmetric finger movement: A functional magnetic resonance imaging study

Patterns of bimanual coordination in which homologous muscles are simultaneously active are more stable than those in which homologous muscles are engaged in an alternating fashion. This may be attributable to the stronger involvement of the dominant motor cortex in ipsilateral hand movements via interaction with the non-dominant motor system, known as neural crosstalk. We used functional magnetic resonance imaging to investigate the neural representation of the interhemispheric interaction during bimanual mirror movements. Thirteen right-handed subjects completed four conditions: sequential finger tapping using the right and left index and middle fingers, bimanual mirror and parallel finger tapping. Auditory cues (3 Hz) were used to keep the tapping frequency constant. Task-related activation in the right primary motor cortex was significantly less prominent during mirror than unimanual left-handed movements. This was mirror- and non-dominant side-specific; parallel movements did not cause such a reduction, and the left primary motor cortex showed no such differential activation across the unimanual right, bimanual mirror, and bimanual parallel conditions. Reducing the contralateral innervation of the left hand may increase the fraction of the force command to the left hand coming from the left primary motor cortex, enhancing the neural crosstalk.

The manifestation of infant hand-use preferences when reaching for objects during the seven- to thirteen-month age period

Handedness is an aspect of hemispheric specialization whose pattern of expression may signal an unusual specialization that in turn, may underlie several developmental psychopathologies. It is generally believed that infant handedness is neither stable nor reliable and hence, cannot be used as an early marker of potential developmental abnormality of hemispheric specialization. We show that infant hand-use preferences for apprehending objects can be reliably assessed and may be relatively stable throughout the 7-13 month age period. However, the results also demonstrate that identifying infant handedness requires assessment using very large sample sizes with multiple assessment periods because it is likely that there may be many more than three patterns in the development of handedness during infancy.

Repetitive TMS over posterior STS disrupts perception of biological motion

Biological motion perception, the recognition of human action depicted in sparse dot displays, is supported by a network of brain areas including the human posterior superior temporal sulcus (pSTS). We have used repetitive transcranial magnetic stimulation (rTMS) to temporarily disrupt cortical activity within the pSTS and subsequently measured sensitivity to biological motion. Sensitivity was measured for canonical (upright) point-light animations and for animations inverted 180 deg, a manipulation that renders biological motion more difficult to recognize. Observers were markedly less sensitive to upright biological motion following pSTS stimulation. In contrast, performance remained normal for inverted biological motion following pSTS stimulation, and normal for upright and inverted biological motion following stimulation over visual motion sensitive area MT+/V5. In connection with previous brain imaging results, our findings demonstrate that normal functioning of the posterior STS is required for intact perception of biological motion.

Hemispheric asymmetry and somatotopy of afferent inhibition in healthy humans

A conditioning electrical stimulus to a digital nerve can inhibit the motor-evoked potentials (MEPs) in adjacent hand muscles elicited by transcranial magnetic stimulation (TMS) to the contralateral primary motor cortex (M1) when given 25-50 ms before the TMS pulse. This is referred to as short-latency afferent inhibition (SAI). We studied inter-hemispheric differences (Experiment 1) and within-limb somatotopy (Experiment 2) of SAI in healthy right-handers. In Experiment 1, conditioning electrical pulses were applied to the right or left index finger (D2) and MEPs were recorded from relaxed first dorsal interosseus (FDI) and abductor digiti minimi (ADM) muscles ipsilateral to the conditioning stimulus. We found that SAI was more pronounced in right hand muscles. In Experiment 2, electrical stimulation was applied to the right D2 and MEPs were recorded from ipsilateral FDI, extensor digitorum communis (EDC) and biceps brachii (BB) muscles. The amount of SAI did not differ between FDI, EDC and BB muscles. These data demonstrate inter-hemispheric differences in the processing of cutaneous input from the hand, with stronger SAI in the dominant left hemisphere. We also found that SAI occurred not only in hand muscles adjacent to electrical digital stimulation, but also in distant hand and forearm and also proximal arm muscles. This suggests that SAI induced by electrical D2 stimulation is not focal and somatotopically specific, but a more widespread inhibitory phenomenon.

How the brain controls repetitive finger movements

Adequate interaction with our physical and social environment requires accurate timing abilities. Since planning and control of movements is closely related to sensorimotor synchronization, the investigation of synchronization abilities may allow insights into fundamental principles of motor behaviour. The finger-tapping task has frequently been used to study the synchronization of one's own movements in relation to external events. Data from behavioural studies gave rise to the assumption that it is not the peripheral event (i.e., finger-tap or pacing signal) that is synchronized but its central representation. The neural foundations of sensorimotor synchronization have only recently been investigated and are still poorly understood. The present article reviews data from neurophysiological studies investigating sensorimotor synchronization to shed light on the neurophysiological processes associated with sensorimotor synchronization. This review focuses on studies investigating neuroelectric and neuromagnetic activity associated with simple repetitive synchronization tasks.

Hemodynamic and metabolic responses to activation, deactivation and epileptic discharges

To investigate the coupling between the hemodynamic and metabolic changes following functional brain activation as well as interictal epileptiform discharges (IEDs), blood oxygenation level dependent (BOLD), perfusion and oxygen consumption responses to a unilateral distal motor task and interictal epileptiform discharges (IEDs) were examined via continuous EEG-fMRI. Seven epilepsy patients performed a periodic (1 Hz) right-hand pinch grip using approximately 8% of their maximum voluntary contraction, a paradigm previously shown to produce contralateral MI neuronal excitation and ipsilateral MI neuronal inhibition. A multi-slice interleaved pulsed arterial spin labeling and T(2)*-weighted gradient echo sequence was employed to quantify cerebral blood flow (CBF) and BOLD changes. EEG was recorded throughout the imaging session and reviewed to identify the IEDs. During the motor task, BOLD, CBF and cerebral metabolic rate of oxygen consumption (CMR(O(2))) signals increased in the contra- and decreased in the ipsilateral primary motor cortex. The relative changes in CMR(O(2)) and CBF were linearly related, with a slope of 0.46 +/- 0.05. The ratio of contra- to ipsilateral CBF changes was smaller in the present group of epilepsy patients than in the healthy subjects examined previously. IEDs produced both increases and decreases in BOLD and CBF signals. In the two case studies for which the estimation criteria were met, the coupling ratio between IED-induced CMR(O(2)) and CBF changes was estimated at 0.48 +/- 0.17. These findings provide evidence for a preserved coupling between hemodynamic and metabolic changes in response to both functional activation and, for the two case studies available, in response to interictal epileptiform activity.

Atypical language representation in epilepsy: implications for injury-induced reorganization of brain function

This review addresses language function and reorganization associated with various forms of epilepsy. Longstanding epilepsy, particularly types with onset early in life, may be associated with changes in the representation of language function in the brain. As a result of this reorganization, language function may be relatively spared despite injury to areas of the brain that normally subserve these functions. We examine the changes seen in language function in two types of epilepsy: hemispheric epilepsy of childhood and focal epilepsies. Findings from behavioral studies, intracarotid amytal testing, intraoperative cortical testing, and more recent functional imaging studies are reviewed. Studying changes in the representation of language function seen in some forms of epilepsy provides information about brain plasticity with implications for other neurologic diseases, as well as for the neuroscientific understanding of how and when functional reorganization may occur.

Asymmetric spatiotemporal patterns of event-related desynchronization preceding voluntary sequential finger movements: a high-resolution EEG study

OBJECTIVE

To study spatiotemporal patterns of event-related desynchronization (ERD) preceding voluntary sequential finger movements performed with dominant right hand and nondominant left hand.

METHODS

Nine subjects performed self-paced movements consisting of three key strokes with either hand. Subjects randomized the laterality and timing of movements. Electroencephalogram (EEG) was recorded from 122 channels. Reference-free EEG power measurements in the beta band were calculated off-line.

RESULTS

During motor preparation (-2 to -0.5s with respect to movement onset), contralateral preponderance of event-related desynchronization (ERD) (lateralized power) was only observed during right hand finger movements, whereas ERD during left hand finger movements was bilateral.

CONCLUSIONS

For right-handers, activation on the left hemisphere during left hand movements is greater than that on the right hemisphere during right hand movements.

SIGNIFICANCE

We provide further evidence for motor dominance of the left hemisphere in early period of motor preparation for complex sequential finger movements.

Ipsilateral Motor Cortex Activity During Unimanual Hand Movements Relates to Task Complexity

Functional imaging studies have revealed recruitment of ipsilateral motor areas during the production of sequential unimanual finger movements. This phenomenon is more prominent in the left hemisphere during left-hand movements than in the right hemisphere during right-hand movements. Here we investigate whether this lateralization pattern is related specifically to the sequential structure of the unimanual action or generalizes to other complex movements. Using event-related fMRI, we measured activation changes in the motor cortex during three types of unimanual movements: repetitions of a sequence of movements with multiple fingers, repetitive “chords” composed of three simultaneous key presses, and simple repetitive tapping movements with a single finger. During sequence and chord movements, strong ipsilateral activation was observed and was especially pronounced in the left hemisphere during left-hand movements. This pattern was evident for both right-handed and, to a lesser degree, left-handed individuals. Ipsilateral activation was less pronounced in the tapping condition. The site of ipsilateral activation was shifted laterally, ventrally, and anteriorly with respect to that observed during contralateral movements and the time course of activation implied a role in the execution rather than planning of the movement. A control experiment revealed that strong ipsilateral activity in left motor cortex is specific to complex movements and does not depend on the number of required muscles. These findings indicate a prominent role of left hemisphere in the execution of complex movements independent of the sequential nature of the task.

The cerebral oscillatory network associated with auditorily paced finger movements

Motor tasks involve neural activity in a spatially distributed network. It is assumed that coherent activity between these brain structures reflects functional connectivity. The aim of the present study was to investigate brain areas associated with a unimanual auditorily paced finger-tapping task and to characterize their dynamic interplay. We examined cerebromuscular and cerebrocerebral coupling in 10 right-handed subjects using recordings of continuous brain activity with a 122-channel whole-head neuromagnetometer while subjects performed the task with both hands consecutively. Additionally, surface EMG of the first dorsal interosseus was measured. Our data demonstrate that an oscillatory network composed of primary sensorimotor cortex, lateral as well as mesial premotor areas, the posterior parietal cortex and thalamus contralateral, and cerebellum and primary auditory cortex ipsilateral to the tapping hand subserves task execution. Connectivity between these areas and direction of coupling agree well with anatomical findings. During the right-hand condition, additional oscillatory activity in the primary sensorimotor cortex ipsilateral to the tapping hand was evident. This result suggests an asymmetric motor control in right-handers. Cerebrocerebral coupling predominantly occurs at 8-12 Hz. Therefore, our data support the hypothesis that coupling at 8-12 Hz in a cerebello-thalamic-cortical network represents a fundamental characteristic of the motor system and provides evidence for the significance of 8-12 Hz oscillations in a large scale network during the execution of simple motor tasks.

Effect of Transcranial Magnetic Stimulation on Bimanual Movements

Transcranial magnetic stimulation (TMS) of the motor cortex can interrupt voluntary contralateral rhythmic limb movements. Using the method of “resetting index” (RI), our study investigated the TMS effect on different types of bimanual movements. Six normal subjects participated. For unimanual movement, each subject tapped either the right or left index finger at a comfortable rate. For bimanual movement, index fingers of both hands tapped in the same (in-phase) direction or in the opposite (antiphase) direction. TMS was applied to each hemisphere separately at various intensities from 0.5 to 1.5 times motor threshold (MT). TMS interruption of rhythm was quantified by RI. For the unimanual movements, TMS disrupted both contralateral and ipsilateral rhythmic hand movements, although the effect was much less in the ipsilateral hand. For the bimanual in-phase task, TMS could simultaneously reset the rhythmic movements of both hands, but the effect on the contralateral hand was less and the effect on the ipsilateral hand was more compared with the unimanual tasks. Similar effects were seen from right and left hemisphere stimulation. TMS had little effect on the bimanual antiphase task. The equal effect of right and left hemisphere stimulation indicates that neither motor cortex is dominant for simple bimanual in-phase movement. The smaller influence of contralateral stimulation and the greater effect of ipsilateral stimulation during bimanual in-phase movement compared with unimanual movement suggest hemispheric coupling. The antiphase movements were resistant to TMS disruption, and this suggests that control of rhythm differs in the 2 tasks. TMS produced a transient asynchrony of movements on the 2 sides, indicating that both motor cortices might be downstream of the clocking command or that the clocking is a consequence of the 2 hemispheres communicating equally with each other.

fMRI signal decreases in ipsilateral primary motor cortex during unilateral hand movements are related to duration and side of movement

Interactions between the primary motor cortices of each hemisphere during unilateral hand movements appear to be inhibitory, although there is evidence that the strengths of these interactions are asymmetrical. In the present study, functional magnetic resonance imaging (fMRI) was used to investigate the effects of motor task duration and hand used on unilateral movement-related BOLD signal increases and decreases in the hand region of primary motor cortex (M1) of each hemisphere in six right-handed volunteers. Significant task-related BOLD signal decreases were observed in ipsilateral M1 during single and brief bursts of unilateral movements for both hands. However, these negative-to-baseline responses were found to intensify with increasing movement duration in parallel with greater task-related increases in contralateral M1. Movement-related BOLD signal decreases in ipsilateral M1 were also stronger for the right, dominant hand than for the left hand in our right-handed subjects. These findings would be consistent with the existence of interhemispheric interactions between M1 of each hemisphere, whereby increased neuronal activation in M1 of one hemisphere induces reduced neuronal activity in M1 of the opposite hemisphere. The observation of a hemispheric asymmetry in inhibition between M1 of each hemisphere agrees well with previous neuroimaging and electrophysiological data. These findings are discussed in the context of current understanding of the physiological origins of negative-to-baseline BOLD responses.

Neurocomputational models of the remote effects of focal brain damage

Sudden localized brain damage, such as occurs in stroke, produces neurological deficits directly attributable to the damaged site. In addition, other clinical deficits occur due to secondary "remote" effects that functionally impair the remaining intact brain regions (e.g., due to their sudden disconnection from the damaged area), a phenomenon known as diaschisis. The underlying mechanisms of these remote effects, particularly those involving interactions between the left and right cerebral hemispheres, have proven somewhat difficult to understand in the context of current theories of hemispheric specialization. This article describes some recent neurocomputational models done in the author's research group that try to explain diaschisis qualitatively. These studies show that both specialization and diaschisis can be accounted for with a single model of hemispheric interactions. Further, the results suggest that left-right subcortical influences may be much more important in influencing hemispheric specialization than is generally recognized.

An interhemispheric asymmetry in motor cortex disinhibition during bimanual movement

The release of short interval intracortical inhibition (SICI) induced by passive bimanual movement was assessed in dominant and non-dominant primary motor cortices (M1). Dual-pulse focal transcranial magnetic stimulation (TMS) was delivered over M1 while the limbs were at rest, and during the mid-flexion phase of contralateral rhythmical wrist flexion-extension. Test and conditioned responses were recorded from flexor carpi radialis (FCR) when the wrist was passively moving alone, during bimanual mirror symmetric passive synchronous movement, and during bimanual passive asynchronous movement. Tonic inhibition was released to a greater extent in the non-dominant M1 than in the dominant M1 during synchronous mirror symmetric movement. This interhemispheric asymmetry was not evident during asynchronous movement. The findings support the idea that the dominant M1 has the capacity to disinhibit homologous representations in the contralateral M1 during synchronous movement, but the non-dominant M1 does not reciprocate to the same extent.

Interhemispheric interaction between human dorsal premotor and contralateral primary motor cortex

We used transcranial magnetic stimulation (TMS) in a paired pulse protocol to investigate interhemispheric interactions between the right dorsal premotor (dPM) and left primary motor cortex (M1) using interstimulus intervals of 4, 6, 8, 10, 12, 16 and 20 ms in ten healthy subjects. A conditioning stimulus over right dPM at an intensity of either 90 or 110% resting motor threshold (RMT) suppressed motor-evoked potentials (MEPs) evoked in the first dorsal interosseous (FDI) muscle by stimulation of left M1. Maximum effects occurred for interstimulus intervals (ISIs) of 8-10 ms. There was no effect if the conditioning stimulus was applied 2.5 cm lateral, anterior or medial to dPM. The effect differed from previously described M1 interhemispheric inhibition in that the threshold for the latter was greater than 90% RMT, whereas stimulation of the dPM at the same intensity led to significant inhibition. In addition, voluntary contraction of the left FDI (i.e. contralateral to the conditioning TMS) enhanced interhemispheric inhibition from right M1 but had no effect on the inhibition from right dPM. Finally, conditioning to right dPM at 90% RMT reduced short-interval intracortical inhibition (SICI; at ISI = 2 ms) in left M1 whilst there was no effect if the conditioning stimulus was applied to right M1. We conclude that conditioning TMS over dPM has effects that differ from the previous pattern of interhemispheric inhibition described between bilateral M1s. This may reflect the existence of commissural fibres between dPM and contralateral M1 that may play a role in bimanual coordination.

Hemodynamic and metabolic responses to neuronal inhibition

Functional magnetic resonance imaging (fMRI) was used to investigate the changes in blood oxygenation level dependent (BOLD) signal, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen consumption (CMR(O(2))) accompanying neuronal inhibition. Eight healthy volunteers performed a periodic right-hand pinch grip every second using 5% of their maximum voluntary contraction (MVC), a paradigm previously shown to produce robust ipsilateral neuronal inhibition. To simultaneously quantify CBF and BOLD signals, an interleaved multislice pulsed arterial spin labeling (PASL) and T(2)*-weighted gradient echo sequence was employed. The CMR(O(2)) was calculated using the deoxyhemoglobin dilution model, calibrated by data measured during graded hypercapnia. In all subjects, BOLD, CBF and CMR(O(2)) signals increased in the contralateral and decreased in the ipsilateral primary motor (M1) cortex. The relative changes in CMR(O(2)) and CBF were linearly related, with a slope of approximately 0.4. The coupling ratio thus established for both positive and negative CMR(O(2)) and CBF changes is in close agreement with the ones observed by earlier studies investigating M1 perfusion and oxygen consumption increases. These findings characterize the hemodynamic and metabolic downregulation accompanying neuronal inhibition and thereby establish the sustained negative BOLD response as a marker of neuronal deactivation.

A compensatory mechanism in unilateral akinetic-rigid syndrome: an fMRI study

The motor mechanisms of a patient with unilateral hand clumsiness in the early stages of akinetic-rigid syndrome were assessed by functional magnetic resonance imaging (fMRI). Movements of the unaffected hand produced activation in the contralateral sensorimotor cortex (SMC) and ipsilateral SMC and superior parietal lobule (SPL). The affected hand activated the bilateral SMCs, supplementary motor areas, and SPLs. We speculated that the bilateral activation indicated recruitment of a pre-existing bilaterally organized large-scale neural network to perform the motor task.

Bimanual recoupling by visual cueing in callosal disconnection

The cerebral control of bimanual movements is not completely understood. We investigated a 59-year-old, right-handed man who presented with an acute bimanual coordination deficit. Magnetic resonance imaging showed a lesion involving the entire corpus callosum, which was found on stereotactic biopsy to be an ischemic infarct. Paired-pulse transcranial magnetic stimulation indicated that the patient had a lack of interhemispheric inhibition, while intracortical inhibition in motor cortex of either side was normal. Functional magnetic resonance imaging showed activation of the left SMA, the bilateral motor cortex and anterior cerebellum during spontaneous bimanual thumb-index oppositions, which were uncoupled as evident from simultaneous electromyographic recordings. In contrast, when the bimanual thumb-index oppositions were cued by a visual stimulus, the movements of both hands were tightly correlated. This synchronized activity was accompanied by additional activations bilateral in lateral occipital cortex, dorsal premotor cortex and cerebellum. The data suggest that the visually cued movements of both hands were recoupled by action of a bihemispheric motor network.

Handedness is mainly associated with an asymmetry of corticospinal excitability and not of transcallosal inhibition

OBJECTIVE

The study aims to compare transcallosal inhibition (TI), as assessed by the paired-pulse transcranial magnetic stimulation (TMS) technique, in a sample of right-handed subjects (RH) and left-handed subjects (LH). Motor thresholds (MTs) and motor evoked potential (MEP) amplitudes were also measured in the two groups, as an index of corticospinal activity.

METHODS

Thirty-two normal subjects (16 RH and 16 LH) were recorded with a paired-pulse TMS paradigm (intensity of both pulses=120% of MT). The inter-stimulus intervals (ISIs) were 2, 4, 6, 8, 10, 12, 14, 16, 18, and 20 ms for both motor cortices, and MEP responses were recorded from the abductor digiti minimi muscles.

RESULTS

Both groups showed a clear TI centred around the 12 ms ISI, but no difference was found as a function of handedness or of hemisphere. On the other hand, the two groups differed in terms of corticospinal activity, since the hand motor dominant hemisphere had lower MTs than the non-dominant one in LH, and larger MEP amplitudes for the right hand were found in RH.

CONCLUSIONS

Results point to a functional asymmetry of the motor cortex on the hand-dominant versus the non-dominant hemisphere, while handedness does not seem associated with functional differences in callosal inhibition, as measured by the inter-hemispheric paired-pulse TMS technique.

Callosal effects of transcranial magnetic stimulation (TMS): the influence of gender and stimulus parameters

Transcranial magnetic stimulation (TMS) of the motor cortex of one hemisphere (conditioning stimulus, CS) inhibits EMG responses evoked in distal hand muscles by a magnetic stimulus given at appropriate interval later over the opposite hemisphere (test stimulus, TS). The common interpretation attributes this effect to an inhibition produced at cortical level via a transcallosal route. The variability of cortical excitability as measured by the interhemispheric paired-pulse (PP) technique has been assessed in healthy subjects in order to compare sub- and supra-threshold intensity of CS (80% versus 120% of individual motor threshold, MT). Within- and between-subject variability relating, respectively, to interhemispheric and gender differences were also assessed. Results point to an efficacy of a magnetic CS on one hemisphere in inhibiting EMG responses of the abductor digiti minimi (ADM) stimulated by a TS delivered over the opposite hemisphere in a range of intervals centered at 12ms. These reductions were produced by the 120% suprathreshold CS, while the 80% subthreshold CS did not affect EMG responses. Females showed a higher transcallosal inhibition than males, suggesting gender differences in interhemispheric connectivity that concern the anterior half of the trunk of the corpus callosum.

Transient human cortical responses during the observation of simple finger movements: a high-resolution EEG study

High-resolution event-related potentials (ERPs) were used to model the hemispherical representation of the transient cortical responses relating to the observation of movement during execution (right or left aimless finger extension). Subjects were seated in front of the observed person and looked at both their own and the observer's hand to receive similar visual feedback during the two conditions. In a visual control condition, a diode light moved at the observed person's hand. A first potential accompanying the movement execution peaked at about +110 msec over the contralateral somatomotor areas. It was followed by a potential (P300) peaking at about +350 msec over the central midline. In contrast, the potentials accompanying the movement observation peaked later over parietal-occipital other than somatomotor areas (N200 peak, +200 msec; P300 peak, +400 msec). Notably, the N200 was maximum in left parietal area whereas the P300 was maximum in right parietal area regardless the side of the movement. They markedly differed by the potentials following the displacement of the diode light. These results suggest a rapid time evolution (approximately 200-400 msec) of the cortical responses characterizing the observation of aimless movements (as opposite to grasping or handling). The execution of these movements would mainly involve somatomotor cortical responses and would be scarcely founded on the visual feedback. In contrast, the observation of the same movements carried out by others would require dynamical responses of somatomotor and parietal-occipital areas (especially of the right hemisphere), possibly for a stringent visuospatial analysis of the motor event.

Transcranial magnetic stimulation in children

Single and paired pulse transcranial magnetic stimulation (TMS) provide a non-invasive, painless method of probing the motor system. These techniques are of particular interest for studying maturation of the motor system and may provide insights into those developmental disabilities strongly associated with specific delays of motor development. This article will review studies using single pulse and paired pulse TMS in children, with particular reference to insights into neurodevelopment in children. It will also briefly touch on the potential of TMS as a diagnostic tool in neurological disorders. It will not address the use of repetitive TMS in children.

Interindividual variability in the hemispheric organization for speech

A PET activation study was designed to investigate hemispheric specialization during speech comprehension and production in right- and left-handed subjects. Normalized regional cerebral blood flow (NrCBF) was repeatedly monitored while subjects either listened to factual stories (Story) or covertly generated verbs semantically related to heard nouns (Gener), using silent resting (Rest) as a common control condition. NrCBF variations in each task, as compared to Rest, as well as functional asymmetry indices (FAI = right minus left NrCBF variations), were computed in anatomical regions of interest (AROIs) defined on the single-subject MNI template. FAIs were predominantly leftward in all regions during both tasks, although larger FAIs were observed during Gener. Subjects were declared "typical" for language hemispheric specialization based on the presence of significant leftward asymmetries (FAI < 0) in the pars triangularis and opercularis of the inferior frontal gyrus during Gener, and in the middle and inferior temporal AROIs during Story. Six subjects (including five LH) showed an atypical language representation. Among them, one presented a right hemisphere specialization during both tasks, another a shift in hemispheric specialization from production to comprehension (left during Gener, right during Story). The group of 14 typical subjects showed significant positive correlation between homologous left and right AROIs NrCBF variations in temporal areas during Story, and in temporal and inferior frontal areas during Gener, almost all regions presenting a leftward FAI. Such correlations were also present in deactivated areas with strong leftward asymmetry (supramarginalis gyrus, inferior parietal region). These results suggest that entry into a language task translates into a hemispheric reconfiguration of lateral cortical areas with global NrCBF increase in the dominant hemisphere and decrease in the minor hemisphere. This can be considered as the setting up of a "language mode", under the control of a mechanism that operates at a perisylvian level. On top of this global organization, regional variations carry on the performance of the cognitive operations specific to the language task to be performed. Hemispheric relationships could be different in atypical subjects, with either between task hemispheric regulation differences or differences in regional specialization.

Analysis of a Network for Finger Interaction during Two-Hand Multi-Finger Force Production Tasks

This study involved an optimization, numerical analysis of a network for two-hand multi-finger force production, analogous in its structure to the double-representation mirror image (DoReMi) network suggested earlier based on neurophysiological data on cortical finger representations. The network accounts for phenomena of enslaving (unintended finger force production), force deficit (smaller force produced by a finger in multi-finger tasks as compared to its single-finger task), and bilateral deficit (smaller forces produced in two-hand tasks as compared to one-hand tasks). Matrices of connection weights were computed, and the results of optimization were compared to the experimental data on finger forces during one- and two-hand maximal force production (MVC) tasks. The network was able to reproduce the experimental data in two-hand experiments with high accuracy (average error was 1.2 N); it was also able to reproduce findings in one-hand multi-finger MVC tasks, which were not used during the optimization procedure, although with a somewhat higher error (2.8 N). Our analysis supports the feasibility of the DoReMi network. It suggests that within-a-hand force deficit and bilateral force deficit are phenomena of different origins whose effects add up. Is also supports a hypothesis that force deficit and enslaving have different neural origins.

Disturbance and recovery of language function: correlates in PET activation studies

Disturbance of neurologic function in disorders of the central nervous system is expressed as an altered activation pattern in functional networks employed by specific tasks and can be studied by functional imaging modalities, e.g., positron emission tomography. Language, a complex brain function, is based on the interplay of a distributed network in which partial functions are executed in various centers, the primary language areas. These areas are hierarchically organized and activated according to the complexity of the specific language task. The specialization of different centers and the lateralization of integrative functions into the dominant (usually left) hemisphere are achieved by collateral and transcallosal inhibition of secondary language areas which normally are not employed for performance of a specific language task.

Organization of action sequences and the role of the pre-SMA

To understand the contribution of the human presupplementary motor area (pre-SMA) in sequential motor behavior, we performed a series of finger key-press experiments. Experiment 1 revealed that each subject had a spontaneous tendency to organize or "chunk" a long sequence into shorter components. We hypothesized that the pre-SMA might have a special role in initiating each chunk but not at other points during the sequence. Experiment 2 therefore examined the effect of 0.5-s, 10-Hz repetitive transcranial magnetic stimulation (rTMS) directed over the pre-SMA. As hypothesized, performance was disrupted when rTMS was delivered over the pre-SMA at the beginning of the second chunk but not when it was delivered in the middle of a chunk. Contrary to the hypothesis, TMS did not disrupt sequence initiation. Experiments 3 and 4 examined whether the very first movement of a sequence could be disrupted under any circumstances. Pre-SMA TMS did disrupt the initiation of sequences but only when subjects had to switch between sequences and when the first movement of each sequence was not covertly instructed by a learned visuomotor association. In conjunction, the results suggest that for overlearned sequences the pre-SMA is primarily concerned with the initiation of a sequence or sequence chunk and the role of the pre-SMA in sequence initiation is only discerned when subjects must retrieve the sequence from memory as a superordinate set of movements without the aid of a visuomotor association. Control experiments revealed such effects were not present when rTMS was applied over the left dorsal premotor cortex.

Event-related desynchronization and excitability of the ipsilateral motor cortex during simple self-paced finger movements

OBJECTIVE

To study the time course of oscillatory EEG activity and corticospinal excitability of the ipsilateral primary motor cortex (iM1) during self-paced phasic extension movements of fingers II-V.

METHODS

We designed an experiment in which cortical activation, measured by spectral-power analysis of 28-channel EEG, and cortical excitability, measured by transcranial magnetic stimulation (TMS), were assessed during phasic self-paced extensions of the right fingers II-V in 28 right-handed subjects. TMS was delivered to iM1 0-1500 ms after movement onset.

RESULTS

Ipsilateral event-related desynchronization (ERD) during finger movement was paralleled by increased cortical excitability of iM1 from 0-200 ms after movement onset and by increased intracortical facilitation (ICF) without changes in intracortical inhibition (ICI) or peripheral measures (F waves). TMS during periods of post-movement event-related synchronization (ERS) revealed no significant changes in cortical excitability in iM1.

CONCLUSIONS

Our findings indicate that motor cortical ERD ipsilateral to the movement is associated with increased corticospinal excitability, while ERS is coupled with its removal. These data are compatible with the concept that iM1 contributes actively to motor control. No evidence for inhibitory modulation of iM1 was detected in association with self-paced phasic finger movements.

SIGNIFICANCE

Understanding the physiological role of iM1 in motor control.

Functional cortical changes in patients with multiple sclerosis and nonspecific findings on conventional magnetic resonance imaging scans of the brain

Recent functional magnetic resonance imaging (fMRI) work has suggested that cortical reorganisation might have an adaptive role in limiting the clinical impact of multiple sclerosis (MS) structural damage. In this study, we investigated whether, in patients with MS, the presence and extent of structural damage of the normal-appearing brain tissue are associated with the extent of the movement-associated pattern of cortical activations. Using fMRI and a general search method, we assessed the patterns of brain activations associated with simple motor tasks in 12 right-handed patients with clinically definite MS and nonspecific T2-weighted abnormalities on conventional MRI scans of the brain and compared them with those from 12 sex- and age-matched right- handed healthy controls. Also investigated were the extent to which the fMRI changes correlated with normal-appearing white matter and grey matter (GM) pathology, measured using diffusion tensor MRI. When performing the simple motor task with the dominant hand, MS patients had more significant activations of the ipsilateral supplementary motor area (SMA), the ipsilateral superior frontal sulcus, the contralateral superior temporal gyrus, and the thalamus than controls. On the contrary, healthy subjects showed more significant activations of the medial part of the contralateral parieto-occipital fissure and the ipsilateral primary sensorimotor cortex (SMC) than patients with MS. In patients with MS, the relative activation of the ipsilateral SMA was correlated with the peak height (r = -0.88, P < 0.001) and position (r = 0.87, P < 0.001) of the GM mean diffusivity histogram. This study shows that cortical reorganisation occurs over a rather distributed sensorimotor network even in patients with MS and nonspecific abnormalities on conventional brain MRI scans. This suggests that, in patients with MS, an increased recruitment of movement-associated cortical network can be elicited by the presence of normal-appearing tissue pathology, which is independent of macroscopic T2-weighted abnormalities.

Reproducibility of callosal effects of transcranial magnetic stimulation (TMS) with interhemispheric paired pulses

Transcranial magnetic stimulation (TMS) of the motor cortex of one hemisphere (conditioning stimulus (CS)) inhibits EMG responses evoked in distal hand muscles by a later magnetic stimulus given at an appropriate interval, over the opposite hemisphere (test stimulus (TS)). This effect is commonly attributed to an inhibition produced at cortical level via a transcallosal route. The present study assessed the reproducibility of the transcallosal inhibition effects in different sessions in healthy subjects. Within- and between-subject variability, relating to interhemispheric differences was also evaluated. A magnetic CS on one hemisphere effectively inhibited EMG responses of the abductor digiti minimi stimulated by a TS delivered over the opposite hemisphere in a range of intervals centered at 12 ms. Even though group effects were reproduced in separate sessions, the high between- and within-subject variability yielded low test-retest correlations. This differentiation forces the definition of reproducibility (or repeatability), as the replication of the same mean curves of EMG reduction, and of reliability, as the between- or within-subject correlations between values of specific EMG measures.

Organization of ipsilateral excitatory and inhibitory pathways in the human motor cortex

Motor cortex stimulation has both excitatory and inhibitory effects on ipsilateral muscles. Excitatory effects can be assessed by ipsilateral motor-evoked potentials (iMEPs). Inhibitory effects include an interruption of ipsilateral voluntary muscle activity known as the silent period (iSP) and a reduction in corticospinal excitability evoked by conditioning stimulation of the contralateral motor cortex (interhemispheric inhibition, IHI). Both iSP and IHI may be mediated by transcallosal pathways. Their relationship to the contralateral corticospinal projection and whether iSP and IHI represent the same phenomenon remain unclear. The neuronal population activated by transcranial magnetic stimulation (TMS) is highly dependent on the direction of the induced current in the brain. We examined the relationship among iMEP, iSP, IHI, and the contralateral corticospinal system by examining the effects of different stimulus intensities and current directions. Surface electromyography (EMG) was recorded from both first dorsal interosseous (FDI) muscles. The iSP in the right FDI muscle was obtained by right motor cortex stimulation during voluntary muscle contraction. IHI was examined by conditioning stimulation of the right motor cortex followed by test stimulation of the left motor cortex at interstimulus intervals (ISIs) of 2-80 ms. The induced current directions tested in the right motor cortex were anterior medial (AM), posterior medial (PM), posterior lateral, and anterior lateral (AL). Contralateral MEPs (cMEPs) had the lowest threshold with the AM direction and the shortest latency with the PM direction. iMEPs were present in 8 of 10 subjects. Both iMEP and IHI did not show significant directional preference. iSP was observed in all subjects with the highest threshold for the AL direction and the longest duration for the AM direction. cMEP, iSP, and IHI all increased with stimulus intensity up to approximately 75% stimulator output. Target muscle activation decreased IHI at 8-ms ISI but had little effect on IHI at 40-ms ISI. iSP and IHI at 8-ms ISI did not correlate at any stimulus intensities and current directions tested, and factor analysis showed that they are explained by different factors. However, active IHI at 40-ms ISI was explained by the same factor as iSP. The different directional preference for cMEP compared with iMEP and IHI suggests that these ipsilateral effects are mediated by populations of cortical neurons that are different from those activating the corticospinal neurons. iSP and IHI do not represent the same phenomenon and should be considered complementary measures of ipsilateral inhibition.

Transcranial magnetic stimulation in neurology

Transcranial magnetic stimulation (TMS) is a non-invasive tool for the electrical stimulation of neural tissue, including cerebral cortex, spinal roots, and cranial and peripheral nerves. TMS can be applied as single pulses of stimulation, pairs of stimuli separated by variable intervals to the same or different brain areas, or as trains of repetitive stimuli at various frequencies. Single stimuli can depolarise neurons and evoke measurable effects. Trains of stimuli (repetitive TMS) can modify excitability of the cerebral cortex at the stimulated site and also at remote areas along functional anatomical connections. TMS might provide novel insights into the pathophysiology of the neural circuitry underlying neurological and psychiatric disorders, be developed into clinically useful diagnostic and prognostic tests, and have therapeutic uses in various diseases. This potential is supported by the available studies, but more work is needed to establish the role of TMS in clinical neurology.

The importance of the dominant hemisphere in the organization of bimanual movements

The successful control of upper limb movements is an essential skill of the human motor system. Yet, the neural organization of bimanual actions remains an issue of debate. Their control can be directed from both hemispheres, or, coordinated motion might be organized from the dominant (left) hemisphere. In order to unravel the neural mechanisms of bimanual behavior, we analyzed the standard task-related and directed coherence between EEG signals picked up over the primary sensorimotor cortices in right-handed subjects during unimanual as well as bimanual in-phase (symmetrical) and anti-phase (asymmetrical) movements. The interhemispheric coherence in the beta frequency band (>13-30 Hz) was increased in both unimanual and bimanual patterns, compared to rest. During unimanual actions, the drive in the beta band from one primary sensorimotor cortex to the other was greater during movement of the contralateral as opposed to ipsilateral hand. In contrast, during bimanual actions, the drive from the dominant to the non-dominant primary sensorimotor cortex prevailed, unless task constraints induced by an external perturbation resulted in a substantial uncoupling of the hand movements, when interhemispheric coherence would also drop. Together, these results suggest that the contralateral hemisphere predominantly organizes unimanual movements, whereas coupled bimanual movements are mainly controlled from the dominant hemisphere. The close association between changes in interhemispheric coupling and behavioral performance indicates that synchronization of neural activity in the beta band is exploited for the control of goal-directed movement.

Shall I Move My Right or My Left Hand?

Abstract Event-related desynchronization/synchronization (ERD/ERS) at alpha (10Hz), beta (20Hz), and gamma (40Hz) bands and movement-related potentials (MRPs) were investigated in right-handed subjects who were “free” to decide the side of unilateral finger movements (“fixed” side as a control). As a novelty, this “multi-modal” EEG analysis was combined with the evaluation of involuntary mirror movements, taken as an index of “bimanual competition.” A main issue was whether the decision regarding the hand to be moved (“free” movements) could modulate ERD/ERS or MRPs overlying sensorimotor cortical areas typically involved in bimanual tasks. Compared to “fixed” movements, “free” movements induced the following effects: (1) more involuntary mirror movements discarded from EEG analysis; (2) stronger vertex MRPs (right motor acts); (3) a positive correlation between these potentials and the number of involuntary mirror movements; (4) gamma ERS over central areas; and (5) preponderance of postmovement beta ERS over left central area (dominant hemisphere). These results suggest that ERD/ERS and MRPs provide complementary information on the cortical processes belonging to a lateralized motor act. In this context, the results on vertex MRPs would indicate a key role of supplementary/cingulate motor areas not only for bimanual coordination but also for the control of “bimanual competition” and involuntary mirror movements.

Correlates of human handedness in primary motor cortex: a review and hypothesis

A review of the research on anatomical and functional asymmetries in human primary motor cortex suggests that the area of hand representation is greater in the dominant than in the non-dominant hemisphere and that there is a greater dispersion of elementary movement representations with more profuse horizontal connections between them. The more profuse interconnections in motor cortex (M1) of the dominant hemisphere might form a neural substrate which favors the formation of experience-dependent excitatory and inhibitory interactions between elementary movement representations. Motor practice might lead to more precise spatiotemporal coordination of the activity of the elementary movement representations in M1 of the dominant than that of the non-dominant hemisphere, thus leading to more dexterous behavior of the dominant than that of the non-dominant hand.

Loss of interhemispheric inhibition on the ipsilateral primary sensorimotor cortex in patients with brachial plexus injury: fMRI study

This functional magnetic resonance imaging study verified an antagonistic pattern in which a concomitant deactivation of ipsilateral primary sensorimotor (SM1) was coupled to the contralateral SM1 activation in healthy controls during unimanual hand grasping. Of note, dramatic reduction of ipsilateral SM1 deactivation (loss of antagonistic pattern) was observed during movement of intact hands by patients with unilateral brachial plexus injury. We propose that the disappearance of the antagonistic pattern of SM1 activities in the patients with brachial plexus injury reflects a reduction of interhemispheric inhibition, which may mirror an adaptive mechanism to functional status.

Effects of callosal lesions in a model of letter perception

During cognitive tasks, the cerebral hemispheres cooperate, compete, and in general, interact via the corpus callosum. Although behavioral studies in normal and split-brain subjects have revealed a great deal about the transcallosal exchange of information, a fundamental question remains unanswered and controversial: Are transcallosal interhemispheric influences primarily excitatory or inhibitory? In this context, we examined the effects of simulating sectioning of the corpus callosum in a computational model of visual letter recognition. Differences were found, following simulated callosal sectioning, in the performance of each individual hemisphere, in the mean activation levels of hemispheres, and in the specific patterns of activity, depending on the nature of the callosal influences. Together with other recent computational modeling results, the findings are most consistent with the hypothesis that transcallosal influences are predominantly excitatory, and they suggest measures that could be examined in future experimental studies to help resolve this issue.

Functional connectivity of human premotor and motor cortex explored with repetitive transcranial magnetic stimulation

Connections between the premotor cortex and the primary motor cortex are dense and are important in the visual guidance of arm movements. We have shown previously that it is possible to engage these connections in humans and to measure the net amount of inhibition/facilitation from premotor to motor cortex using single-pulse transcranial magnetic stimulation (TMS). The aim of this study was to test whether premotor activation can affect the excitability of circuits within the primary motor cortex (M1) itself. Repetitive TMS (rTMS), which is known to produce effects that outlast the train at the site of stimulation, was given for 20 min at 1 Hz over premotor, primary motor, and sensory areas of cortex at an intensity of 80% of the active motor threshold for the motor hand area. The excitability of some corticocortical connections in M1 was probed by using paired-pulse testing of intracortical inhibition (ICI) and intracortical facilitation (ICF) with a coil placed over the motor cortex hand area. rTMS over the premotor cortex, but not other areas, changed the time course of the ICI/ICF for up to 1 hr afterward without affecting motor thresholds or motor-evoked potential recruitment. The cortical silent period was also shortened. The implication is that rTMS at a site distant from the motor cortex can change the excitability of circuits intrinsic to the motor cortex.

Central mechanisms of finger interaction during one- and two-hand force production at distal and proximal phalanges

In this study we used changes in the relative involvement of different muscle groups during force production at the distal (DT) and proximal (PR) phalanges to test and modify a hypothesis on the central organization of multi-finger control for tasks involving non-homologous elements in the two hands. Ten subjects produced maximal force with different finger combinations. Two symmetrical (PR/PR and DT/DT) and two asymmetrical (PR/DT and DT/PR) combinations of force application sites in the two hands were used. During one-hand tasks, higher forces were produced at the PR site. In multi-finger tasks, total peak force was smaller than the sum of peak forces in single-finger tasks by the involved fingers (force deficit). Force production by some fingers of a hand was accompanied by involuntary force production by other fingers (enslaving). Force deficit and enslaving were both higher at the PR site. Two-hand tasks were accompanied by an additional drop in the force of individual fingers, i.e., bilateral deficit (BD). When symmetrical sites of force production were used in the two hands, BD was lower for symmetrical finger groups than for asymmetrical groups. During tests at asymmetrical sites, BD was higher and did not depend on symmetry of involved finger groups. We conclude that within-a-hand force deficit and enslaving are likely to be of a central, neural origin. An earlier introduced hypothesis has been expanded assuming that excitatory projections to contralateral finger representations exist only for homologous elements (sub-synergies) of a multi-finger force production synergy, while only inhibitory projections connect non-homologous elements.

Plasticity of language networks in patients with brain tumors: a positron emission tomography activation study

We investigated plasticity of language networks exposed to slowly evolving brain damage. Single subject 0-15-water language activation positron emission tomography studies were analyzed in 61 right-handed patients with brain tumors of the left hemisphere, and 12 normal controls. In controls, activations were found in left Brodmann's Area (BA)44 and BA45, superior posterior temporal gyrus bilaterally, and right cerebellum. Patients additionally activated left BA46, BA47, anterior insula, and left cerebellum. Superior temporal activation was less frequent, and activations in areas other than posterior temporal gyrus were found bilaterally. Frontolateral activations within the nondominant hemisphere were only seen in patients (63%) with frontal or posterior temporal lesions. Laterality indices of frontolateral cortex showed reversed language dominance in 18% of patients. Laterality indices of the cerebellum were negatively correlated with language performance. Two compensatory mechanisms in patients with slowly evolving brain lesions are described: An intrahemispheric mechanism with recruitment of left frontolateral regions other than classic language areas; and an interhemispheric compensatory mechanism with frontolateral activation in the nondominant hemisphere. The latter one was only found in patients with frontal or posterior temporal lesions, thus supporting the hypothesis that right frontolateral activations are a disinhibition phenomenon.